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Hernandez AL, Lingas EO, Juarez W, Villa A, Palefsky J. Using an anti-racist research framework to design studies of oral human papillomavirus and oropharyngeal cancer in San Francisco: rationale and protocol for the Health Equity and Oral Health in People living with HIV (HEOHP) qualitative study. BMJ Open 2024; 14:e091474. [PMID: 39317508 PMCID: PMC11423734 DOI: 10.1136/bmjopen-2024-091474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/14/2024] [Indexed: 09/26/2024] Open
Abstract
INTRODUCTION The goal of our research programme is to develop culturally appropriate patient-specific interventions for primary and secondary prevention of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) among people living with HIV (PLWH); PLWH are at a higher risk for OPC than the general population and, as with many cancers, there are disparities in OPC health outcomes by race and ethnicity. Our study incorporates an anti-racist research framework that proposes considering racism as a foundational sociocultural system that causes ill health. We expand the framework to include biases due to gender, sexual orientation, HIV status and membership in other non-dominant groups. Our research programme focuses on HPV-related OPC among people living with PLWH, and on how intersecting identities may impact an individual's experience with oral health, obtaining regular and appropriate oral healthcare, knowledge and perceptions of oral HPV infection, risk factors for OPC and HPV vaccination. METHODS AND ANALYSIS We will follow a grounded theory (GT) qualitative research methodology using focus group discussions (FGDs) to collect data. We will invite PLWH with intersecting identities to participate in one of 12-18 FGDs with 5-8 participants per group. Focus groups will be formed based on self-reported domains, including race, ethnicity, gender identity, sexual orientation and other identities that could impact oral health, such as smoking status, experience with homelessness or experience with drug use disorders. We do not know which aspects of intersecting identities are most salient to accessing oral healthcare. Using FGDs will allow us to gain this knowledge in a setting where participants can build on and reinforce shared understandings about oral healthcare. Following our GT methodology, analysis will occur concurrently with data collection, and emerging concepts or theories may result in changes to focus group guide questions. Initial focus group questions will be organised around our main objectives: (1) to identify individual, interpersonal and structural health equity factors that serve as barriers or facilitators to oral health status and care; (2) to explore knowledge and perceptions about causes, risk factors, prevention and screening for oral or OPC and (3) to elicit recommendations for improving access to regular and appropriate oral healthcare and suggestions on engaging PLWH from diverse identity groups in prevention interventions. ETHICS AND DISSEMINATION All methods and procedures were approved by the University of California, San Francisco, Institutional Review Board (approval number: 23-39307) and are in accordance with the Declaration of Helsinki of 1975, as revised in 2000. Participants are required to provide informed consent. The results of this study will be presented at scholarly meetings and published in peer-reviewed journals. In addition, a lay summary of results will be created and distributed to our participants and community through our website and social media. TRIAL REGISTRATION NUMBER NCT06055868.
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Affiliation(s)
- Alexandra L Hernandez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Public Health Program, Touro University California College of Education and Health Sciences, Vallejo, California, USA
| | | | - William Juarez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Alessandro Villa
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Joel Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Fakhrjahani I, Tiwari T, Jessani A. A Scoping Review of Oral Health Outcomes and Oral Health Service Utilization of 2SLGBTQ+ People. JDR Clin Trans Res 2024; 9:199-211. [PMID: 37968914 PMCID: PMC11184910 DOI: 10.1177/23800844231206359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Oral health is an integral aspect of overall well-being and quality of life. Population groups such as two-spirit, lesbian, gay, bisexual, transgender, and queer, including other sexual and gender minorities (2SLGBTQ+), have reported poor oral health outcomes. Therefore, the aim of this review was to investigate the extent and scope of the literature describing 2SLGBTQ+ oral health outcomes, including unmet oral health needs and patterns of oral health care service utilization, as well as the risk factors affecting both. METHODS A comprehensive search strategy was developed to review the scope of the literature pertinent to unmet oral health needs and factors affecting access to oral health care among 2SLGBTQ+ members, globally. In total, 6 databases were searched with a combination of keywords relevant to 2SLGBTQ+ oral health status and oral health care utilization. RESULTS Our review identified 10 studies that met the eligibility criteria. Five out of 10 studies were based in India, 4 in the United States, and 1 in Brazil. Two studies reported poorer oral health outcomes among transgender people as compared with cisgender people, while 2 studies reported similar patterns of dental service utilization between their transgender and cisgender participants. Five studies explored the personal and structural risk factors associated with poor oral health outcomes, including financial affordability and income level and perceived discrimination, including instances of misgendering in health care settings. However, further comprehensive studies must be conducted to validate the trends and findings reported by the studies in the review and to generate data from diverse regional contexts. CONCLUSIONS Our review identified that the extent of the literature in this research area is sparse and scarce. The evidence indicates poorer oral health status among 2SLGBTQ+ communities. Wider studies with diverse, representative samples are required to gain a comprehensive understanding of 2SLGBTQ+ oral health outcomes. KNOWLEDGE TRANSFER STATEMENT The results of this review will undoubtedly be important for many years to come as 2SLGBTQ+ oral health equity is prioritized by experts in public health dentistry. This review will allow other researchers to understand and fill literature gaps regarding 2SLGBTQ+ oral health outcomes, furthering this area of research.
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Affiliation(s)
- I. Fakhrjahani
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - T. Tiwari
- Department of Community Dentistry and Population Health, School of Dental Medicine, University of Colorado, Aurora, CO, USA
| | - A. Jessani
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Kang J, Wu J, Aggarwal VR, Shiers D, Doran T, Palmier-Claus J. Investigating the Relationship between Oral Health and Severe Mental Illness: Analysis of NHANES 1999-2016. Dent J (Basel) 2024; 12:191. [PMID: 39056978 PMCID: PMC11276391 DOI: 10.3390/dj12070191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVES To explore whether: (i) people with severe mental illness (SMI) experience worse oral health than the general population, and (ii) the risk factors for poor oral health in people with SMI. METHODS Cross-sectional data were extracted from the National Health and Nutrition Examination Survey (1999-2016), including on self-rated oral health, oral pain, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. Ordinal logistic regression and zero-inflated negative binomial models were used to explore predictors of oral health outcomes. RESULTS There were 53,348 cases included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.60, 95% CI: 1.34-1.92). In people with SMI, risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes. CONCLUSIONS People with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Performing regular physical exercise and flossing may lower the risk of poor oral health, while smoking and diabetes may increase the risk. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes in people with SMI.
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Affiliation(s)
- Jing Kang
- Faculty of Dentistry, Oral, and Craniofacial Sciences, King’s College London, London SE1 9RT, UK
| | - Jianhua Wu
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London E1 4NS, UK
| | | | - David Shiers
- Division of Psychology & Mental Health, University of Manchester, Manchester M13 9PL, UK;
| | - Tim Doran
- Health Services & Policy, University of York, York YO10 5DD, UK;
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK;
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire PR5 6AW, UK
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Mkumbuzi NS. Women's rugby for all: Toward an intersectional women's rugby research agenda. Eur J Sport Sci 2024. [PMID: 38874753 DOI: 10.1002/ejsc.12127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024]
Abstract
Women rugby players are participating in the sport at the highest levels to date. However, despite this increase in participation, sports sciences and sports medicine/sports physiotherapy (SEMS) research output has not mirrored this increase. Females have hormonally mediated anatomical and physiological profiles, which may have implications for rugby performance, injury risk and rehabilitation outcomes. However, hormonal fluctuations and the physiological differences between the sexes are not the only contributors to sex-related differences in the rugby experience. Rugby is a highly gendered environment, which operates within a hegemonic masculine norm and marginalises female and women athletes. Further, while women players in general are underrepresented in sports sciences and SEMS research, women rugby players and experts from ethnic minorities and the Global South are near invisible in the literature as they are marginalised on multiple fronts. Sports sciences and SEMS research should take an intersectional lens to investigate the joint relationship between the various sources of inequity in rugby. Intersectional research in women rugby players would encourage the conceptualisation and analysis of the complex social inequalities that the most marginalised women players and those who simultaneously negotiate multiple identities experience. Such data can better inform federation-level interventions and policy changes to address the needs of historically marginalised player populations as our research portfolio will be more representative of the world's rugby population.
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Affiliation(s)
- Nonhlanhla Sharon Mkumbuzi
- Department of Sport, Exercise, and Rehabilitation, Northumbria University, Newcastle upon Tyne, England
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
- Department of Rehabilitation, Midlands State University, Gweru, Zimbabwe
- NtombiSport (PTY) Ltd., Cape Town, South Africa
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Soares GH, Haag D, Bastos JL, Mejia G, Jamieson L. Triple Jeopardy in Oral Health: Additive Effects of Immigrant Status, Education, and Neighborhood. JDR Clin Trans Res 2024:23800844241253518. [PMID: 38877725 DOI: 10.1177/23800844241253518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
PURPOSE To estimate the additive effects of parent's nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia. METHODS Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI). RESULTS Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI3: -0.14; 95% confidence interval [CI]: -1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI3: 0.43; 95% CI: -2.08, 2.95). CONCLUSION Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds. KNOWLEDGE TRANSFER STATEMENT Our analysis underscores the necessity for policies and public health strategies targeting dental caries-related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.
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Affiliation(s)
- G H Soares
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - D Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - J L Bastos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - G Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - L Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
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Gatti-Reis L, Silva-Sousa AC, Pordeus IA, Paiva SM, Mattos FF. Dental research related to COVID-19 in Brazil: research presented at the 38th SBPqO Meeting. Braz Oral Res 2024; 38:e035. [PMID: 38747822 PMCID: PMC11376627 DOI: 10.1590/1807-3107bor-2024.vol38.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/10/2023] [Indexed: 09/20/2024] Open
Abstract
The aim of this study was to identify and describe the characteristics of coronavirus (COVID-19)-disease related dental research in Brazil presented at the 38th Annual Meeting of the Brazilian Division of the International Association for Dental Research (SBPqO). A search was carried out in the proceedings of the meeting to retrieve all abstracts. Those containing the term "COVID-19" in titles, abstracts, or keywords, and/or those of which the scope approached a COVID-19-related topic were included. The variables extracted from abstracts were: presenter category, field of study, design, data collection method, population, affiliation, and authors' gender. Descriptive and inferential statistics were used, with a significance level of α = 0.05. The search retrieved 185 abstracts, 5 did not meet study eligibility criteria and were excluded. COVID-19-related research was presented by either aspiring/associate members (67.8%) or beginner members (32.2%). Data collection methods were predominantly digitally mediated (65%), followed by secondary data use (25%), and in-person data collection (7.2%). Irrespective of the role of authorship, there were a ratio of two female authors to each male. Among the last authors, the ratio was three females to each male. Female lead authors more frequently came from the Southeast region (71.8%; p = 0.470). There was an association between presenter category and study design (p = 0.012), clinical and epidemiological studies were more concentrated among experienced presenters. In conclusion, female dental researchers affiliated to southeastern institutions approached the topic of pandemic more frequently than male colleagues. The use of digital technology for data collection may have long-lasting impacts on the teaching and publication of dental research.
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Affiliation(s)
- Luisa Gatti-Reis
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Pediatric Dentistry, Belo Horizonte, MG, Brazil
| | - Alice Corrêa Silva-Sousa
- Universidade de São Paulo - USP, School of Dentistry, Department of Restorative Dentistry, São Paulo, SP, Brazil
| | - Isabela Almeida Pordeus
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Pediatric Dentistry, Belo Horizonte, MG, Brazil
| | - Saul Martins Paiva
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Pediatric Dentistry, Belo Horizonte, MG, Brazil
| | - Flávio Freitas Mattos
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Social and Preventive Dentistry, Belo Horizonte, MG, Brazil
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Fleming E, Alkhubaizi Q, Cunha-Cruz J, Dariotis WM. Building a workforce of diverse women leaders: Understanding intersectional identities. J Dent Educ 2024; 88 Suppl 1:685-689. [PMID: 38758067 DOI: 10.1002/jdd.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/13/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Women have made significant advancements in the dentist workforce, growing from 20% of dentists in 2005 to 34.5% in 2020. Women have also made inroads in academic dentistry. While much scholarship has documented a growing feminization in dentistry and efforts to promote gender equity in the profession, there has been less exploration of the intersectional identities of these women. This manuscript explores how academic dentistry can support diverse women's leadership focusing on intersectional identities. METHODS Applying the theoretical framework of intersectionality, we assess publicly available data to explore the percentages of faculty and deans who are women of color. Drawing upon best practices in higher education and our personal experiences, we explore opportunities to increase participation and support the advancement of women of color in academia. RESULTS In the academic year 2018-2019, of the 5066 full-time faculty members, 40.5% were women. Minoritized women comprised 13.4% of full-time faculty members, compared to White women who were 20.6% of full-time faculty. Minoritized women comprised 7.3% of dental school deans, compared to White women who were 17.6% of deans. CONCLUSION Intersectionality allows for a deeper examination of women in academic dentistry. Women of color are often erased in discussions about women in academic dentistry, even as the profession celebrates the progress made by women. Embracing the intersectional identities of women and by extension, people who identify as gender non-confirming may help dental schools to become humanistic environments where faculty and leadership represent the growing diversity in the profession and in the world.
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Affiliation(s)
- Eleanor Fleming
- University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Qoot Alkhubaizi
- University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Joana Cunha-Cruz
- University of Alabama at Birmingham, School of Dentistry, Birmingham, Alabama, USA
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Anticona C, Suominen AL, Holgerson PL, Gustafsson PE. Impact of an oral care subsidization reform on intersectional inequities in self-rated oral health in Sweden. Int J Equity Health 2024; 23:63. [PMID: 38504240 PMCID: PMC10953229 DOI: 10.1186/s12939-024-02121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Oral health in Sweden is good at the population level, but seemingly with persisting or increasing inequities over the last decades. In 2008, a major Swedish reform introduced universal partial subsidies to promote preventive care and reduce the treatment cost for patients with extensive care needs. This study aimed to apply an intersectional approach to assess the impact of the 2008 subsidization reform on inequities in self-rated oral health among adults in Sweden over the period 2004-2018. METHODS Data from 14 national surveys conducted over 2004-2018 were divided into three study periods: pre-reform (2004-2007), early post-reform (2008-2012) and late post-reform (2013-2018). The final study population was 118,650 individuals aged 24-84 years. Inequities in self-rated oral health were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 intersectional strata defined by gender, age, educational level, income, and immigrant status. RESULTS Overall, the prevalence of poor self-rated oral health decreased gradually after the reform. Gender-, education- and income-related inequities increased after the reform, but no discernible change was seen for age- or immigration-related inequities. The majority of intersectional strata experienced patterns of persistently or delayed increased inequities following the reform. CONCLUSIONS Increased inequities in self-rated oral health were found in most intersectional strata following the reform, despite the seemingly positive oral health trends at the population level. Applying an intersectional approach might be particularly relevant for welfare states with overall good oral health outcomes but unsuccessful efforts to reduce inequities.
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Affiliation(s)
- Cynthia Anticona
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE-90187, Sweden.
- Department of Odontology, Umeå University, Umeå, SE-90187, Sweden.
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Teaching Unit, Kuopio University Hospital, Kuopio, Finland
| | - Pernilla Lif Holgerson
- Department of Odontology, Section of Pediatric Dentistry, Umeå University, Umeå, SE-90187, Sweden
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE-90187, Sweden
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Lalloo R. Gender and geographic diversity of global oral health organisations. Br Dent J 2024:10.1038/s41415-024-7176-3. [PMID: 38438718 DOI: 10.1038/s41415-024-7176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 03/06/2024]
Abstract
Introduction Diversity of leadership of global oral health organisations is critical to ensure a global agenda.Aim To analyse the gender and geographic diversity of global oral health organisations.Methods Publicly available data on the gender of their staff and leadership, and congress locations, were analysed. Gender was allocated from photographs if available, and using Genderize, an online allocation platform. Location of leaders and global congresses were analysed by country, region and World Bank income category. The organisations analysed were the International Association of Dental Research (IADR), FDI World Dental Federation, International Federation of Dental Hygienists (IFDH) and 15 dental specialist global associations.Results The majority of headquarter staff in the IADR (76%) and FDI (84%) are female. Gender diversity in the leadership differs across the various organisations, with recent progress towards gender parity. The IFDH was and is exclusively female-led. The majority of leaders are from high-income countries in Europe and North America. Of the 370 congress locations, 90% were held in high-income countries.Conclusion There is recent progress towards gender diversity in the leadership; however, this leadership is essentially from high-income countries. There is an urgent need to publicly commit to diversity goals and implement strategies to reflect the oral health workforce and be truly diverse and global.
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Affiliation(s)
- Ratilal Lalloo
- Associate Professor, Teaching and Research, The University of Queensland, The School of Dentistry, Brisbane, Australia.
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Balasooriyan A, van der Veen MH, Bonifácio CC, Dedding C. Understanding parental perspectives on young children's oral health (≤ 4 years) growing up in a disadvantaged neighbourhood of Amsterdam, the Netherlands: an exploratory study. BMC Public Health 2024; 24:627. [PMID: 38413935 PMCID: PMC10900557 DOI: 10.1186/s12889-024-18073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Families' understanding towards oral health problems among young children is poorly studied. More insight into parents' experiences, especially of those living in disadvantaged neighbourhoods, is needed to address persistent oral health inequalities. This qualitative study aims to explore parental perspectives on children's oral health (≤ 4 years) and the opportunities they see to improve children's oral health. METHODS Forty-seven mothers and five fathers with different migration backgrounds from a disadvantaged neighbourhood in Amsterdam, the Netherlands, participated in our study. Semi-structured interviews (n = 27), participant observations (n = 7) and one focus group discussion were conducted. A thematic data analysis was used. RESULTS Parents describe their daily life with young children as busy, hectic and unpredictable. Parents seem to be most concerned about parenting. Mothers, in particular, feel fully responsible for raising their children and managing daily complexities. While most parents value their children's oral health, they all experience challenges. Parents find it hard to limit daily candy intake and to handle unwilling children during tooth brushing. They feel limited support for these issues from their household, social network and professionals. CONCLUSION Parental struggles in children's oral health are complex and interrelated as they occur across family, societal, community and professional levels. Given the complex daily reality of families with young children, establishing and maintaining healthy oral health habits seems not at the top of parents' minds. They ask for advice in the upbringing of their children backed up by social support, increased attention to children's oral health within the community and professional assistance. Collaborating with parents as knowledgeable partners might be the first step in acting upon the endeavour to address oral health inequality among young children.
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Affiliation(s)
- Awani Balasooriyan
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands.
| | - Monique H van der Veen
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands
| | - Clarissa Calil Bonifácio
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands
| | - Christine Dedding
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centre (UMC), Amsterdam, The Netherlands
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Hedges J, Poirier B, Soares G, Haag D, Sethi S, Santiago PR, Cachagee M, Jamieson L. Journeying towards decolonising Aboriginal and Torres Strait Islander oral health re-search. Community Dent Oral Epidemiol 2023; 51:1232-1240. [PMID: 37294001 DOI: 10.1111/cdoe.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Arguably, the deficit narrative of oral health inequities, perpetuated by colonial re-search agendas, media and sociopolitical discourse, contributes to oral disease burden and fatalism among Aboriginal and Torres Strait Islander Peoples. There remains a need to evolve the way oral health is understood, in a manner that reflects the lived experiences of Aboriginal and Torres Strait Islander Peoples. METHODS This paper proposes decolonising methodologies as a strategy to ensure oral health re-search creates more equitable oral health outcomes and realities for Aboriginal and Torres Strait Islander Communities. Anchored by a critical reflection of the failure of dominant oral health inequity re-search practices to address Indigenous oral health, both in Australia and internationally, we propose five explicit pathways for decolonising Aboriginal and Torres Strait Islander oral health re-search. RESULTS We argue the need for (1) positionality statements in all re-search endeavours, (2) studies that honour reciprocal relationships through the development of proposals that ask questions and follow models based on Traditional Knowledges, (3) the development of culturally secure and strengths-based data capturing tools, (4) frameworks that address the intersection of multiple axes of oppression in creating inequitable conditions and (5) decolonising knowledge translation techniques. CONCLUSION Importantly, we recognize that re-search will never be entirely 'decolonised' due to the colonial foundations upheld by academic institutions and society more broadly; however, as oral health re-searchers, we ascertain that there is an ethical compulsion to drive decolonising re-search pursuits that produce equitable oral health outcomes for Aboriginal and Torres Strait Islander Communities.
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Affiliation(s)
- Joanne Hedges
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Brianna Poirier
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Gustavo Soares
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Dandara Haag
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Sneha Sethi
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Pedro Ribeiro Santiago
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Madison Cachagee
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Lisa Jamieson
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
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Neville P. Decolonising dental educational research: reflections from a white researcher. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1679-1695. [PMID: 37074593 PMCID: PMC10113732 DOI: 10.1007/s10459-023-10228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
While there is an emerging scholarship on decolonising dentistry, the debate about reflexivity, positionality and white privilege in dental educational research and practice is still at a developmental stage. This article aims to contribute to this nascent debate by contemplating the question- is it appropriate, or possible, for a white researcher to undertake decolonisation work in dental education? If so, what would it entail or 'look' like? To answer this important question, the author offers a reflective account of their ethical and epistemological journey with this very question. This journey begins with how I, a white researcher, first became aware of the everyday racism experienced by my racially and ethnically minoritized students, the whiteness of dental educational spaces and how my white privilege and position as a dental educator consciously and unconsciously implicated me in these processes of exclusion and discrimination. While this revelation led to a personal commitment to do better in my practice, both as an educator and a researcher, I continue to struggle with my white ignorance and white fragility as I strive to make my work more inclusive. To illustrate this, I discuss an ethnodrama project on everyday racism that I lead on and how, despite choosing a more democratic research method, hegemonic whiteness continued to make its presence felt through my 'going it alone' method of work. This reflective account reaffirms that regular and routine self-reflection is key to ensuring that racialised inappropriate and damaging assumptions, frameworks of thinking, and ways of working are checked for. However, my praxis won't evolve through critical introspection alone. I need to be open to making mistakes, educating myself about racism and anti-racist practice, asking for help and guidance from my minoritized colleagues and more importantly, committing to working with people from minoritized communities rather than on them.
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Affiliation(s)
- Patricia Neville
- University of Bristol, Bristol, UK.
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
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13
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Gatti-Reis L, Mattos FF, Pordeus IA, Martins-Júnior PA, Coutinho DCDO, Perazzo MF, Paiva SM. Leadership through a gender lens: Disparities in Dental Research. Braz Dent J 2023; 34:100-109. [PMID: 38133084 PMCID: PMC10742361 DOI: 10.1590/0103-644020230555959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to analyze the 100 most-cited papers in Dentistry, with a focus on female leadership in dental research. Papers were retrieved from the Web of Science Core Collection (WoS- CC) in the category 'Dentistry, Oral Surgery & Medicine'. Gender was assessed through WoS-CC, Scopus, ResearchGate, social media, institutional websites, and software that assigns gender according to first names (https://genderapi.io). Characteristics of authors in leadership roles were retrieved, such as affiliation, publication history, citations, H factor, and i500. The 100 most-cited papers in Dentistry were authored by 394 researchers, 326 (82.7%) men, and 68 (17.3%) women - there were 4.8 male authors for each female. Among the lead authors, there were 11.3 males for each female. Among female senior authors, there were 7 males for each female. Among lead/senior authors of the 100 most-cited papers (first and last authors, respectively), 18 were women. There was an increase in the participation of women in the top cited papers regardless of authorship role across the six decades, with a peak of two female authors in the first decade of the 21st century. For female authors in leadership roles, their publication history shows the time between their first and last papers in WoS-CC ranged from 4 to 42 years for lead authors and 1 to 39 years for senior authors. Women were found to be largely underrepresented as leaders of the 100 most-cited papers, highlighting pervasive gender inequalities in dental research publications.
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Affiliation(s)
- Luisa Gatti-Reis
- Department of Paediatric Dentistry, Federal University of Minas Gerais - 6627 Av. Antônio Carlos, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Flávio Freitas Mattos
- Department of Social and Preventive Dentistry, Federal University of Minas Gerais- 6627 Av. Antônio Carlos, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Isabela Almeida Pordeus
- Department of Paediatric Dentistry, Federal University of Minas Gerais - 6627 Av. Antônio Carlos, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Paulo Antônio Martins-Júnior
- Department of Paediatric Dentistry, Federal University of Minas Gerais - 6627 Av. Antônio Carlos, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | | | - Matheus França Perazzo
- Department of Dental Public Health, Universidade Federal de Goiás - Av. Universitária, s/n.º - St. Leste Universitário, Goiânia, Goiás, Brazil
| | - Saul Martins Paiva
- Department of Paediatric Dentistry, Federal University of Minas Gerais - 6627 Av. Antônio Carlos, Belo Horizonte, 31270-901, Minas Gerais, Brazil
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14
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Leite JR, Bomfim RA. Sedentary behaviour and traumatic dental injuries in adolescents: A population-based study. Dent Traumatol 2023; 39:478-482. [PMID: 37010883 DOI: 10.1111/edt.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE Analyse factors associated with dental trauma in 12-year-old adolescents. METHODS An epidemiological survey was carried out in the five largest cities in the state of Mato Grosso do Sul, Brazil. Data on traumatic dental injuries (TDI) based on the World Health Organization (WHO), sociodemographic characteristics and individual clinical and behavioural characteristics in 615 adolescents were collected. Univariate and adjusted multilevel logistic regressions were performed to test the association of dental trauma with behavioural and sociodemographic factors. The study was approved by the Ethics Committee (CAAE number 85647518.4.0000.0021). RESULTS The prevalence of TDI at 12 years was 3.4% (95% CI 1.8; 6.4). In the adjusted models, clinical characteristics of adolescents such as overjet >3 mm (OR = 1.51 [95% CI 1.00; 2.41]) were associated with trauma. Sociodemographic characteristics such as female sex (OR = 0.13 [95% CI 0.07; 0.25]), income above the poverty level (OR = 0.34 [95% CI 0.15; 0.78]), who declared themselves white (OR = 0.23 [95% CI 0.11; 0.47]) and with sedentary behaviour (OR = 0.69 [95% CI 0.59; 0.80]) were associated with trauma, as protective factors. CONCLUSION Sociodemographic, behavioural and individual clinical characteristics were associated with TDI in adolescents. Oral health teams should focus on the most vulnerable groups, encouraging the use of mouthguards and access to treatment services.
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Affiliation(s)
- Jean Ribeiro Leite
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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15
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Bastos JL, Fleming E, Haag DG, Schuch HS, Jamieson LM, Constante HM. The Relations between Systems of Oppression and Oral Care Access in the United States. J Dent Res 2023; 102:1080-1087. [PMID: 37464815 DOI: 10.1177/00220345231184181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
We applied a structural intersectionality approach to cross-sectionally examine the relationships between macro-level systems of oppression, their intersections, and access to oral care in the United States. Whether and the extent to which the provision of government-funded dental services attenuates the emerging patterns of associations was also assessed in the study. To accomplish these objectives, individual-level information from over 300,000 respondents of the 2010 US Behavioral Risk Factor Surveillance System was linked with state-level data for 2000 and 2010 on structural racism, structural sexism, and income inequality, as provided by Homan et al. Using multilevel models, we investigated the relationships between systems of oppression and restricted access to oral health services among respondents at the intersections of race, gender, and poverty. The degree to which extended provision of government-funded dental services weakens the observed associations was determined in models stratified by state-level coverage of oral care. Our analyses bring to the fore intersectional groups (e.g., non-Hispanic Black women and men below the poverty line) with the highest odds of not seeing a dentist in the previous year. We also show that residing in states where high levels of structural sexism and income inequality intersect was associated with 1.3 greater odds (95% confidence interval, 1.1-1.5) of not accessing dental services in the 12 mo preceding the survey. Stratified analyses demonstrated that a more extensive provision of government-funded dental services attenuates associations between structural oppressions and restricted access to oral health care. On the basis of these and other findings, we urge researchers and health care planners to increase access to dental services in more effective and inclusive ways. Most important, we show that counteracting structural drivers of inequities in dental services access entails providing dental care for all.
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Affiliation(s)
- J L Bastos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - E Fleming
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - D G Haag
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - H S Schuch
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - L M Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - H M Constante
- Department of Sociological Studies, The University of Sheffield, Sheffield, United Kingdom
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16
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Madera M, Delgado-Angulo EK, Bashir NZ, Bernabe E. The intersections of socioeconomic position, gender, race/ethnicity and nationality in relation to oral conditions among American adults. Community Dent Oral Epidemiol 2023; 51:644-652. [PMID: 36786413 DOI: 10.1111/cdoe.12845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate how gender, socioeconomic position (SEP), race/ethnicity and nationality intersect to structure social inequalities in adult oral health among American adults. METHODS Data from adults aged 20 years or over who participated in the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were analysed. The outcomes were poor self-rated oral health and edentulism among all adults (n = 24 541 and 21 446 participants, respectively) and untreated caries and periodontitis among dentate adults (n = 16 483 and 9829 participants, respectively). A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted for each outcome, by nesting individuals within 48 intersectional strata defined as combinations of gender, SEP, race/ethnicity and nationality. Intersectional measures included the variance partition coefficient (VPC), the proportional change in variance (PCV) and predicted excess probability due to interaction. RESULTS Substantial social inequalities in the prevalence of oral conditions among adults were found, which were characterized by high between-stratum heterogeneity and outcome specificity. The VPCs of the simple intersectional model showed that 9.4%-12.7% of the total variance in the presentation of oral conditions was attributed to between-stratum differences. In addition, the PCVs from the simple intersectional model to the intersectional interaction model showed that 84.1%-97.1% of the stratum-level variance in the presentation of oral conditions was attributed to the additive effects of gender, SEP, race/ethnicity and nationality. The point estimates of the predictions for some intersectional strata were suggestive of an intersectional interaction effect. However, the 95% credible intervals were very wide and the estimations inconclusive. CONCLUSIONS This analysis highlights the value of the intersectionality framework to understand heterogeneity in social inequalities in oral health. These inequalities were mainly due to the additive effect of the social identities defining the intersectional strata, with no evidence of interaction effects.
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Affiliation(s)
- Meisser Madera
- Faculty of Dentistry, University of Cartagena, Cartagena, Colombia
| | - Elsa Karina Delgado-Angulo
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nasir Zeeshan Bashir
- School of Dentistry, University of Leeds, Leeds, UK
- School of Mathematics and Statistics, The University of Sheffield, Sheffield, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- DentStat Consulting Ltd, Cardiff, Wales, UK
| | - Eduardo Bernabe
- Institute of Dentistry, Queen Mary University of London, London, UK
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17
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Perera I, Amarasinghe H, Jayasinghe RD, Udayamalee I, Jayasuriya N, Warnakulasuriya S, Johnson NW. An overview of the burden of oral cancer in Sri Lanka and its inequalities in the face of contemporary economic and social malaise. Community Dent Oral Epidemiol 2023. [PMID: 37377376 DOI: 10.1111/cdoe.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES Over the past several decades, oral cancer has been the most common malignancy among Sri Lankan males and the top 10 cancer among females, disproportionately affecting low socio-economic groups. Sri Lanka is a lower-middle-income developing country (LMIC), currently striking through an economic crisis, and social and political unrest. Occurring at an accessible body site and predominantly attributed to potentially modifiable health-related behaviours, oral cancer should be preventable and controllable. Unfortunately, broader contextual factors that are socio-cultural, environmental, economic, and political and mediated through social determinants of people's lives consistently hinder progress. Many LMICs with a high burden of oral cancer are now gripped by economic crises, consequent social and political unrest, all compounded by reduced public health investments. The aim of this review is to provide a critical commentary on key aspects of oral cancer epidemiology including inequalities, using Sri Lanka as a case study. METHODS The review synthesizes evidence from multiple data sources, such as published studies, web-based national cancer incidence data, national surveys on smokeless tobacco (ST) and areca nut use, smoking and alcohol consumption, poverty headcount ratios, economic growth, and Gross Domestic Product (GDP) health expenditure. National trends in the oral cancer, ST use, smoking and alcohol consumption in Sri Lanka are identified alongside inequalities. RESULTS Using these evidence sources, we discuss 'where are we now?', together with the availability, accessibility and affordability of oral cancer treatment services, oral cancer prevention and control programmes, tobacco and alcohol control policies, and finally, outline macroeconomic perspectives of Sri Lanka. CONCLUSIONS Finally, we speculate, 'where to next?' Our overarching goal of this review is to initiate a critical discourse on bridging the gaps and crossing the divides to tackle oral cancer inequalities in LMIC such as Sri Lanka.
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Affiliation(s)
- Irosha Perera
- Preventive Oral Health Unit, National Dental Hospital (Teaching), Colombo, Sri Lanka
| | - Hemantha Amarasinghe
- Department of Community Dental Health, Faculty of Dental Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Ruwan D Jayasinghe
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Iresha Udayamalee
- School of Dentistry and Oral Health, Menzies Health Institute Queensland, Griffith University, Griffith, Queensland, Australia
| | - Nadeena Jayasuriya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College, London and the WHO Collaborating Centre for Oral Cancer, London, UK
| | - Newell W Johnson
- School of Dentistry and Oral Health, Menzies Health Institute Queensland, Griffith University, Griffith, Queensland, Australia
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College, London and the WHO Collaborating Centre for Oral Cancer, London, UK
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18
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Fleming E, Smith CS, Quiñonez CR. Centring anti-oppressive justice: Re-envisioning dentistry's social contract. Community Dent Oral Epidemiol 2023. [PMID: 36966445 DOI: 10.1111/cdoe.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/14/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES We re-envision dentistry's social contract and elaborate on the idea that it is not neutral and free from such things as racism and white supremacy and can act as a tool of oppression. METHODS We critique social contract theory through examination of classical and contemporary contract theorists. More specifically, our analysis draws from the work of Charles W. Mills, a philosopher of race and liberalism, as well as the theoretical and praxis framework of intersectionality. RESULTS Social contract theory supports hierarchies and inequities that may be used to sustain unfair and unjust differences in oral health between social groups. When dentistry's social contract becomes a tool of oppression, its practice does not promote health equity but reinforces damaging social norms. CONCLUSION Dentistry must embrace an anti-oppression framing of equity and elevate the principle of justice to one of liberation and not just fairness. In doing so, the profession can better understand itself, act more equitably and empower practitioners to advocate for justice in health and healthcare in its fullest sense. Anti-oppressive justice supports health not as merely an obligation but as a human duty.
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Affiliation(s)
- Eleanor Fleming
- University of Maryland School of Dentistry, 650 West Baltimore Street, Baltimore, Maryland, 21230, USA
| | - Carlos S Smith
- Virgina Commonwealth University, 1101 E. Leigh Street, P.O. Box 980566, Richmond, Virginia, 23298-0566, USA
| | - Carlos R Quiñonez
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, N6A 5C1, Canada
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19
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Baker SR, Heaton LJ, McGrath C. Evolution and development of methodologies in social and behavioural science research in relation to oral health. Community Dent Oral Epidemiol 2023; 51:46-57. [PMID: 36756884 DOI: 10.1111/cdoe.12821] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 02/10/2023]
Abstract
The aim of this introductory paper is to provide an overview of key methodological developments in social and behavioural research in oral health. In the first section, we provide a brief historical perspective on research in the field. In the second section, we outline key methodological issues and introduce the seven papers in the theme. Conceptual models can contextualize research findings and address the 'why' and 'how' instead of 'what' and 'how many'. Many models exist, albeit they need to be evaluated (and adapted) for use in oral health research and in specific settings. The increasing availability of big data can facilitate this with data linkage. Through data linkage, it is possible to explore and understand in a broader capacity the array of factors that influence oral health outcomes and how oral health can influences other factors. With advances in statistical approaches, it is feasible to consider casual inferences and to quantify these effects. There is a need for not only individual efforts to embrace causal inference research but also systematic and structural changes in the field to yield substantial results. The value of qualitative research in co-producing knowledge with and from human participants in addressing 'the how' and 'the why' factors is also key. There have been calls to employ more sophisticated qualitative methods together with mixed methods approaches as ways of helping to address the complex or Wicked Problems in population oral health. In the final section, we outline possible future methodological directions in social and behavioural oral health research including participatory approaches and the development of core outcome sets. Our overriding goal in the paper is to facilitate a critical debate in relation to methodological issues which can be used to improve understanding and generate knowledge in population oral health and that this, in turn, will help inform oral health policy and practices.
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Affiliation(s)
- Sarah R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Lisa J Heaton
- CareQuest Institute for Oral Health, Boston, Massachusetts, USA.,Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Colman McGrath
- Applied Oral Sciences & Community Dental Care, The University of Hong Kong, Hong Kong, Hong Kong
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20
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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21
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Macdonald ME. The Necessity of qualitative research for advancing oral health. Community Dent Oral Epidemiol 2023; 51:67-70. [PMID: 36749669 DOI: 10.1111/cdoe.12787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 02/08/2023]
Abstract
Researchers are engaged with producing knowledge. Through this knowledge production, they make claims about the world. For applied health researchers, our knowledge production is both a scientific as well as a moral activity. Increasingly, oral health researchers are turning to qualitative research, a research approach that takes science and morality seriously. Qualitative research pushes researchers to think about the different worlds in which people live and work, and endeavours to generate data that reflect those worlds. This paper argues that humans are complex, and that qualitative approaches are necessary for understanding how we are all deeply embedded in historical, social, cultural and political contexts, and why this matters when thinking about oral health. This paper also dispels myths about the limitations of qualitative research and proposes future directions to improve the sophistication of qualitative oral health sciences.
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Affiliation(s)
- Mary Ellen Macdonald
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Québec, Canada.,Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada
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22
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Goodwin M, Henshaw M, Borrelli B. Inequities and oral health: A behavioural sciences perspective. Community Dent Oral Epidemiol 2023; 51:108-115. [PMID: 36753398 DOI: 10.1111/cdoe.12826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The importance of tackling ongoing dental health inequities, observed both within and across countries, cannot be overstated. Alarmingly, health inequities in some areas are widening, resulting in an urgent need to act. The objective of this commentary is to explore oral health inequities through the lens of behavioral science and discuss adapting evidence based interventions for populations experiencing health inequities. METHOD/RESULTS The first section of this paper aims to describe the role of health disparities and inequities within oral health, with a specific focus on behaviours. The determinants, from upstream to downstream, and the interplay between these levels of intervention are discussed. This is followed by an overview of oral health promotion interventions, again with a focus on behaviours, which could potentially improve oral health while also taking into account oral health inequities. It is essential to translate evidence-based interventions (EBIs) to populations that have the greatest burden of disease. The second section of this paper discusses the rationale for cultural adaption of EBIs, criteria to justify EBIs and considers different cultural adaptation strategies necessary for the development and testing of effective, engaging, equitable and culturally relevant interventions. CONCLUSIONS We conclude with future directions for the development of theory-based multi-level interventions, guided by extent evidence-based interventions, and transdisciplinary approaches to science and key stakeholders such as patients, providers and payers.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Michelle Henshaw
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Belinda Borrelli
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,The University of Manchester, Manchester, UK
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23
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Fleming E, Bastos JL, Jamieson L, Celeste RK, Raskin SE, Gomaa N, McGrath C, Tiwari T. Conceptualizing inequities and oppression in oral health research. Community Dent Oral Epidemiol 2023; 51:28-35. [PMID: 36749670 DOI: 10.1111/cdoe.12822] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 02/08/2023]
Abstract
Major sociohistorical processes have profound effects on oral health, with impacts experienced through structural oppression manifested in policies and practices across the lifespan. Structural oppression drives oral health inequities and impacts population-level oral health. In this global perspective paper, we challenge old assumptions about oral health inequities, address misleading conceptualizations in their description and operation and reframe oral health through the lens of intersecting systems of oppression. Furthermore, we emphasize the need for oral health researchers to explore causal pathways through which oppression harms oral health and engage in social science concepts to understand the root causes of oral health inequities fully. Finally, we call on policymakers, dental scholars and decision makers to consider health equity in all policies and to take a systems-oriented approach to effectively address oral health inequities.
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Affiliation(s)
| | - João L Bastos
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Roger K Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sarah E Raskin
- iCubed Initiative Oral Health Core, Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Virginia, USA
| | - Noha Gomaa
- Oral Diagnostic Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Colman McGrath
- Applied Oral Sciences & Community Dental Care, University of Hong Kong, Hong Kong, Hong Kong
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
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24
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Anticona C, Lif Holgerson P, Gustafsson PE. Assessing inequities in unmet oral care needs among adults in Sweden: An intersectional approach. Community Dent Oral Epidemiol 2022; 51:428-435. [PMID: 36583509 DOI: 10.1111/cdoe.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/23/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The goal of the Swedish oral healthcare system is to achieve good oral health and equitable access to care for the entire population. However, considerable inequities in oral health and care are evident and occur across a range of social dimensions. This study uses an intersectional approach to examine complex inequities in unmet oral care needs among adults in Sweden over the period 2004-2021. METHODS Data were obtained from 14 Health on Equal Terms surveys conducted during 2004-2021. The final sample was 129 473 individuals aged 26-84 years. Applying intersectional analysis of individual heterogeneity and discriminatory accuracy, inequities in unmet oral care needs were estimated across 48 intersectional strata defined by gender, age, educational level, individual disposable income and immigrant status. RESULTS A high risk of unmet oral care needs was found among strata consisting of immigrants and those with low income. However, being an immigrant and/or having a low income did not universally entail a high risk but varied by the social position along other axes, particularly age and education. The discriminatory accuracy was moderate. CONCLUSION Groups with certain social disadvantages are highly heterogeneous themselves. An intersectionality approach is important to prevent the risk of stigmatizing large heterogenous groups while failing to identify the most vulnerable strata. The discriminatory accuracy analysis suggested that further policy and/or interventions may be the most effective if approaching the whole population, combined with selected targeted interventions directed at the most disadvantaged social strata.
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Affiliation(s)
| | | | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Marcus K, Balasubramanian M, Short SD, Sohn W. Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers. BMC Public Health 2022; 22:2199. [PMID: 36443774 PMCID: PMC9703727 DOI: 10.1186/s12889-022-14513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Oral healthcare is paramount and inextricably linked to well-being. Yet, the evidence indicates that culturally and linguistically diverse (CALD) migrant communities have unequal access to mainstream dental services due to several barriers. The purpose of this study was to investigate the oral healthcare experiences, attitudes and barriers to oral healthcare utilisation in CALD mothers. METHODS A qualitative study with semi-structured interviews was conducted within a social constructivism epistemology. CALD mothers who identified as non-English speaking, foreign country born, with a child under 12, were recruited though purposive snowball sampling. Questions probed oral healthcare experiences, barriers, enablers, and attitudes. Verbatim typed transcripts were thematically analysed using grounded methodology. RESULTS Thirty-three CALD mothers participated; twenty from India, five from Fiji, four from China, two from Nepal and one each from Israel and Macedonia. Languages included Cantonese, Fiji-Hindi, Gujrati, Hebrew, Hindi, Kannada, Mandarin, Maharashtrian, Macedonian, Nepalese, Punjabi, Sanskrit, Telegu and Urdu. Cost was the foremost barrier to oral healthcare services, followed by Confidence in quality care for the provision of services and treatment. Confusion in navigating a public and private healthcare system was highlighted and Competing priorities took precedence. Complacency referred to 'no need' or lack of urgency in dental care. Subsequently, dental hesitancy (superordinate theme) described the patterning of data as comprising the five 'C' factors and was theorised as the dental hesitancy phenomenon to explain the occurrence of delay or avoidance in utilising dental care. CONCLUSION Findings highlight the utility of the dental hesitancy phenomenon unearthed within this study. CALD mothers explained five 'C' dimensions: cost, confidence, confusion, competing priorities and complacency as barriers to accessing timely dental care. Multisectoral collaboration between healthcare systems, universal health coverage and primary sector support is required to address dental hesitancy in CALD mothers. Further, this study contributes to the field of behavioural and social sciences in oral health and augments the literature on dental avoidance.
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Affiliation(s)
- Kanchan Marcus
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Madhan Balasubramanian
- grid.1014.40000 0004 0367 2697Health Care Management, College of Business, Government and Law, Flinders University, Adelaide, Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Stephanie D. Short
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Woosung Sohn
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
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Leason I, Longridge N, Mathur MR, Nickpour F. An opportunity for inclusive and human-centred design. Br Dent J 2022; 233:607-612. [DOI: 10.1038/s41415-022-5101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022]
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Reginaldo I, Fernandes IAM, Nuernberg GN, Bastos JL. Race in public health dentistry: a critical review of the literature. Rev Saude Publica 2022; 56:57. [PMID: 35766786 PMCID: PMC9239422 DOI: 10.11606/s1518-8787.2022056004173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To carry out a critical review of the literature on the use of race, color, and ethnicity in the field of public health dentistry. METHODS A literature search was conducted in MEDLINE via PubMed for articles published between 2014 and 2019. Using a data extraction form, we collected information on (1) bibliographic characteristics of the selected papers; (2) race, color, and ethnicity of the study participants and their sociodemographic profiles; and (3) the extent to which the original publications followed the recommendations by Kaplan and Bennett (2003) on the use of race, color, or ethnicity in biomedical research. RESULTS Our initial search identified 2,032 articles, 53 of which were selected for full-text examination and assessment following pre-established eligibility criteria. Around 60% (n = 32) of the included studies did not justify the use of race, color, or ethnicity in their analyses, and 9% (n = 5) took these variables as indicators of the participants’ genetic makeup. On the other hand, 68% (n = 36) of the reviewed papers considered race, color, and ethnicity as risk markers – not risk factors – for adverse oral health outcomes, whereas 80% (n = 42) adjusted racial/ethnic inequities for a range of socioeconomic and demographic factors in statistical models. Only one study (2%) explicitly took race, color, or ethnicity as a contextually dependent dimension of the participants’ identities. CONCLUSION Our findings indicate that research on oral health inequities is often based on reductionist and stigmatizing conceptions of race, color, or ethnicity. Such harmful misconceptions should be replaced with anti-racist narratives in order to effectively address racial oral health inequities.
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Affiliation(s)
- Isabela Reginaldo
- Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
| | | | | | - João Luiz Bastos
- Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
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Raskin S, Fleming E. Oral Health Equity Must Address Oppression: On the BSSOH Consensus Statement. J Dent Res 2022; 101:616-618. [PMID: 35302416 PMCID: PMC9127930 DOI: 10.1177/00220345221081247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health (Consensus Statement) is a transformational contribution to oral health research synthesizing a wide array of conceptual, methodological, and disciplinary concerns and offering strategies to improve scientific inquiry. The Consensus Statement explicates global oral health equity as a foundational concern of our field. Given this context, a key concern is missing from the statement: oppression!
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Affiliation(s)
- S.E. Raskin
- L. Douglas Wilder School of Government and
Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - E. Fleming
- University of Maryland School of Dentistry,
Baltimore, MD, USA
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Mörelius E, Munns A, Smith S, Nelson HJ, McKenzie A, Ferullo J, Gill FJ. Pediatric and child health nursing: A three-phase research priority setting study in Western Australia. J Pediatr Nurs 2022; 63:39-45. [PMID: 34973465 DOI: 10.1016/j.pedn.2021.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Priority settings are important to plan and direct future research. The aim of this study was to identify the top ten pediatric and child health nursing research priorities from the perspectives of consumers, community, and healthcare professionals in Western Australia. DESIGN AND METHODS This study used an adapted James Lind Alliance Priority Setting Partnership design with three phases. 1) A planning workshop to inform a survey. 2) A survey using five open-ended-questions distributed between October 2020 and January 2021 through social media and healthcare professionals' emails. Responders' statements were analyzed with content analysis. 3) A consensus workshop to finalize and rank the themes. RESULTS The planning workshop participants (n = 25) identified gaps such as community child healthcare and confirmed lack of consumer engagement in previous studies. The survey responses (n = 232) generated 911 statements analyzed into 19 themes. The consensus workshop participants (n = 19) merged and added themes, resulting in 16 final themes. The top three ranked themes were: 'access to service', 'mental health and psychological wellbeing', and 'communication'. CONCLUSIONS The research themes are necessarily broad to capture the wide range of issues raised, reflecting the scope of pediatric and child health nursing. PRACTICE IMPLICATIONS The priorities will inform future research to be directed to areas of priority for stakeholders who have often not had a say in setting the research agenda.
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Affiliation(s)
- Evalotte Mörelius
- Child and Adolescent Health Service, Nedlands, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, WA, Australia.
| | - Ailsa Munns
- Child and Adolescent Health Service, Nedlands, WA, Australia; Curtin School of Nursing, Curtin University, WA, Australia
| | - Stephanie Smith
- Child and Adolescent Health Service, Nedlands, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, WA, Australia
| | - Helen J Nelson
- Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Anne McKenzie
- Community Engagement Telethon Kids Institute, Nedlands, WA, Australia
| | - Jade Ferullo
- Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Fenella J Gill
- Child and Adolescent Health Service, Nedlands, WA, Australia; Curtin School of Nursing, Curtin University, WA, Australia
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Bastos JL, Constante HM, Schuch HS, Haag DG, Jamieson LM. How do state-level racism, sexism, and income inequality shape edentulism-related racial inequities in contemporary United States? A structural intersectionality approach to population oral health. J Public Health Dent 2022; 82 Suppl 1:16-27. [PMID: 35726462 DOI: 10.1111/jphd.12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research on racial oral health inequities has relied on individual-level data with the premise being that the unequal distribution of dental diseases is an intractable problem. We address these insufficiencies by examining the relationships between structural racism, structural sexism, state-level income inequality, and edentulism-related racial inequities according to a structural intersectionality approach. METHODS Data were from two sources, the 2010 survey of the U.S. Behavioral Risk Factor Surveillance System, and Patricia Homan et al.'s (2021) study on the health impacts from interlocking systems of oppression. While the first contains information on edentulism from a large probabilistic sample of older (65+) respondents, the second provides estimates of racism, sexism, and income inequality across the US states. Taking into account a range of individual characteristics and contextual factors in multilevel models, we determine the extent to which structural forms of marginalization underlie racial inequities in edentulism. RESULTS Our analysis reveals that structural racism, structural sexism, and state-level income inequality are associated with the overall frequency of edentulism and the magnitude of edentulism-related racial inequities, both individually and intersectionally. Coupled with living in states with both high racism and sexism (but not income inequality), the odds of edentulism were 60% higher among non-Hispanic Blacks, relative to Whites residing where these structural oppressions were at their lowest. CONCLUSIONS These findings provide evidence that racial oral health inequities cannot be disentangled from social forces that differentially allocate power and resources among population groups. Mitigating race-based inequities in oral health entails dismantling the multifaceted systems of oppression in the contemporary U.S. society.
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Affiliation(s)
- João L Bastos
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Helena M Constante
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Helena S Schuch
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Dandara G Haag
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
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Fleming E, Raskin SE, Brody E. From describing disparities to understanding why disparities exist: Anti-racist methods to support dental public health research. J Public Health Dent 2022; 82 Suppl 1:73-78. [PMID: 35726470 PMCID: PMC9541958 DOI: 10.1111/jphd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Racism is understudied in the oral health literature at the same time that race is overutilized as an explanatory factor in study design. Social and behavioral methodologies offer conceptual models that can be used to include racism in dental public health questions. In addition, interdisciplinary and mixed methods approaches allow for understanding racism as an underlying cause of social and health disparities and exploring solutions that address historical, institutional, social, political, and economic drivers of oral health inequity, while recognizing the limits of measuring racism quantitatively. In a collective acknowledgement of the limitations of conventional methods, there are new opportunities to explore how qualitative and mixed methods research can serve as drivers for both social justice and health equity, while building and sustaining a diverse research workforce that can better close these disparities and offer antiracist solutions to oral health inequities.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Sarah E Raskin
- iCubed Oral Health Core, L. Douglas Wilder School of Government and Public Affairs and Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erica Brody
- Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
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Sokoto KC, Platt LF, Alexander LA, Foxman B, Shaffer JR, Marazita ML, McNeil DW. Racism in oral healthcare settings: Implications for dental care-related fear/anxiety and utilization among Black/African American women in Appalachia. J Public Health Dent 2022; 82 Suppl 1:28-35. [PMID: 35726465 PMCID: PMC9542871 DOI: 10.1111/jphd.12523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the association of racism in oral healthcare settings and dental care-related fear/anxiety with dental utilization among Black/African American women in Appalachia. METHODS We analyzed self-report measures of racism in oral healthcare settings, dental care-related anxiety and fear, recency of a dental visit, and demographic information from 268 pregnant women participating in the Center for Oral Health Research in Appalachia (COHRA) SMILE cohort. All participants self-identified as African American or Black and resided in Appalachia (i.e., either West Virginia or Pittsburgh, PA). RESULTS Over one-third of the participants reported at least one instance of racism in oral healthcare settings, with "not being listened to" due to their race or color as the most frequent issue (24.4%). Clinically significant levels of dental care-related anxiety and fear were reported by 14.3% of the sample. A mediational model demonstrated that the experience of racism in oral healthcare settings was a significant predictor of dental fear/anxiety, and that dental fear/anxiety was a significant predictor of dental utilization. There was a significant relationship between racism in oral healthcare settings and dental utilization only when mediated by the presence of dental care-related fear and anxiety. CONCLUSIONS Together, experiences of racism in oral healthcare settings and dental care-related fear/anxiety are predictive of decreased dental utilization for Black/African American women living in Appalachia. This study provides insight into racism in oral healthcare settings as a social determinant of dental anxiety/fear and inequities in dental utilization.
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Affiliation(s)
- Kalo C. Sokoto
- Counseling Psychology, Department of Counseling and Learning SciencesWest Virginia UniversityMorgantownWest VirginiaUSA
- Center for Oral Health Research in AppalachiaUniversity of Pittsburgh and West Virginia University, Pittsburgh, Pennsylvania, and MorgantownWest VirginiaUSA
| | - Lisa F. Platt
- Counseling Psychology, Department of Counseling and Learning SciencesWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Linda A. Alexander
- Center for Oral Health Research in AppalachiaUniversity of Pittsburgh and West Virginia University, Pittsburgh, Pennsylvania, and MorgantownWest VirginiaUSA
- Department of Social and Behavioral SciencesSchool of Public Health, West Virginia UniversityMorgantownWest VirginiaUSA
| | - Betsy Foxman
- Center for Oral Health Research in AppalachiaUniversity of Pittsburgh and West Virginia University, Pittsburgh, Pennsylvania, and MorgantownWest VirginiaUSA
- School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - John R. Shaffer
- Center for Oral Health Research in AppalachiaUniversity of Pittsburgh and West Virginia University, Pittsburgh, Pennsylvania, and MorgantownWest VirginiaUSA
- Department of Human GeneticsUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Oral and Craniofacial SciencesUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Craniofacial and Dental GeneticsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Mary L. Marazita
- Center for Oral Health Research in AppalachiaUniversity of Pittsburgh and West Virginia University, Pittsburgh, Pennsylvania, and MorgantownWest VirginiaUSA
- Department of Human GeneticsUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Oral and Craniofacial SciencesUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Craniofacial and Dental GeneticsUniversity of PittsburghPittsburghPennsylvaniaUSA
- Clinical and Translational Science Institute and Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Daniel W. McNeil
- Center for Oral Health Research in AppalachiaUniversity of Pittsburgh and West Virginia University, Pittsburgh, Pennsylvania, and MorgantownWest VirginiaUSA
- Department of PsychologyWest Virginia UniversityMorgantownWest VirginiaUSA
- Department of Dental Public Health & Professional PracticeWest Virginia UniversityMorgantownWest VirginiaUSA
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Neville P. The 'leaky' BAME pipeline in UK dentistry. Br Dent J 2022:10.1038/s41415-022-3930-6. [PMID: 35145241 DOI: 10.1038/s41415-022-3930-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022]
Abstract
Introduction There are growing calls for dentistry to debate, critique and analyse the role and place of racism in the profession. This article supports this debate and considers whether people from Black, Asian and Minority Ethnic (BAME) backgrounds experience barriers to progressing in the profession.Aims To create a BAME 'pipeline' model illustrating how ethnicity shapes the composition of the dental profession in the UK.Material and methods Publicly available datasets from UK higher education agencies and professional dental associations were identified, examined and collated to create a BAME pipeline model.Results Registrants from the BAME category do not share similar experiences within the dental profession compared to white registrants. The experiences of British Asian people appear to be more favourable, vis-à-vis access to dental schools and progression to the General Dental Council register, compared to Black British people and other UK minority ethnic groups. Black British registrants experience blockages at all stages of their career progression, most notably when accessing dental schools, with only 2% commencing dental studies. All BAME groups 'leak' out of the dental pipeline at clinical academia. There are insufficient data to ascertain whether there are additional 'leaks' at the career specialisation stage.Discussion and conclusion The UK BAME dental pipeline is a leaky one and is in need of urgent action and repair.
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Affiliation(s)
- Patricia Neville
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
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Karam SA, Schuch HS, Demarco FF, Barros FC, Horta BL, Correa MB. Social and racial inequity in self-rated oral health in adults in Southern Brazil. CAD SAUDE PUBLICA 2022; 38:e00136921. [DOI: 10.1590/0102-311x00136921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to estimate social and racial inequalities in self-rated oral health in adults from the Brazilian birth cohort study. This study belongs to 1982 Pelotas (Brazil) birth cohort study. Data from this study was collected for oral health conditions 31 years old (Oral Health Study). The outcome was self-rated oral health, dichotomized into positive (good/very good) and negative (regular/bad/very bad). Analyses were stratified by gender, racial/skin color groups, schooling level and income. For statistical analysis, the slope index of inequality (SII) and the concentration index (CIX) were used. The prevalence of negative self-rated oral health was 36.1%. Social inequalities were observed in self-rated oral health in both absolute and relative terms. A SII of -30.0 (95%CI: -43.6; -16.4) was observed for income, and -27.7 (95%CI: -41.9; -13.4) for schooling level. Both the individuals’ income and the schooling level had negative CIX (CIXincome -14.6 [95%CI: -21.2; -8.0] and CIXschooling level -14.1 [95%CI: -20.7; -7.5]). Furthermore, the prevalence of negative self-rated oral health in black/brown/indigenous individuals from the highest income/schooling level was comparable to prevalence of the outcome in the white individuals belonging to the lowest income/schooling levels. This study results demonstrate racial disparities in oral health regardless of income and schooling levels. Furthermore, a higher concentration of negative self-rated oral health was identified among the most socioeconomically vulnerable individuals. Our findings reinforce the presence of racial and socioeconomic inequalities in oral health.
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